Leadership Practices for Eliminating Patient Harm: Inquiry

In the second part of ours series on leadership and adaptive practices to address prescription errors, we learn how a listening tour is used to diagnose the adaptive work needed. The story continues as Marilyn works with two colleagues – a surgeon, Bill, and a nurse, Kathryn – to generate a list of possible compelling questions, one of which will be the focus of her listening tour. (Read the first part of the series here.)

Together they generate the following open-ended questions:

Do you believe it is possible to eliminate patient harm caused by incorrect prescriptions? Why or why not?

How does our system of prescription preparation actually work, especially in times of high demand?

What are the specific conversations and actions that produce a completely delivered prescription?

What are examples of interference with flawless delivery of a patient prescription?

How do I and others directly or indirectly contribute to the possibility of a prescription error?

Marilyn acknowledges to herself that while the last question may lead to some discomfort for her and others, it is the one she finds most compelling.

Having this compelling question in mind, Marilyn now identifies who she will ask in order to obtain the multiple perspectives needed to diagnose the situation. Her list consists of people who report to her, people who work on the same level as her, and people who she reports to. However, she also considers people “outside” her normal work area such as pharmacists, patients, and information technology experts. She creates a list of about 12 people to start with.

Having this conversation may be easier said than done. Marilyn will need to provide “the why” of what she is doing prior to asking her question. She may need to deepen her relationship with the person by, for example, gaining a better understanding of their role.

When she asks her compelling question, she listens quietly instead of defending, arguing, advising or addressing the person’s perceptions. She gathers the person’s response verbatim so that later she can display all the responses together. Her conversation is not just a passive bit of data gathering. She actively listens, asking questions for clarity such as “What do you mean by that?” She asks follow-on probing questions to expose the person’s thinking, and is continuously curious as to how the person responds to the questioning.

To a certain extent, in each conversation Marilyn is putting herself and those she speaks with on the hook for dealing with the issue. The conversation itself is shaping culture. As part of putting herself on the hook, Marilyn promises she will return after collecting all her data and share what she has learned from the listening tour to see what her respondents think about her conclusions.

Marilyn spends about two weeks having individual 15-30 minute conversations with each of the 12 people. She notices that her listening tour has already raised the visibility of the prescription issue within her hospital. And while most of the comments are supportive in tone, there already seems to be opposition to her acting outside her formal role. She wonders if this “opposition” is part of the adaptive challenge she is working on.

Marilyn places all her verbatim responses or “data” in a document and meets with her two colleagues, Bill and Kathryn. They review the responses and “make meaning” by assembling them into themes that might begin diagnosing the challenge. They challenge each other with different interpretations of the data to preclude favoring their individual values and views.

In the third part of our series the themes from the listening tour are presented and Marilyn takes action on one theme. We invite you to follow Marilyn’s lead and do a listening tour within your organization as well as make meaning from the data you collect.

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